Violence in Psychiatry

9781316135839

Focusing on violence from assessment, through underlying neurobiology, to treatment and other recommendations for practice, this book will be of interest to forensic psychiatrists, general adult psychiatrists, psychiatric residents, psychologists, psychiatric social workers and rehabilitation therapists.

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Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Introduction

Forensic hospital systems contain a significant number of patients who engage in acts of violence. Persistent aggressive behavior may be due to insufficient treatment of the various origins of such violence, which can include, but are not limited to, psychotic aggression, impulsive aggression due to mood disorders, schizophrenia, personality disorders, trauma or ADHD, and predatory aggression due to personality disorders [1]. While psychotic violence is the least difficult to treat, it is also the least frequently occurring form of violence, with impulsive being both the most common and most difficult to treat [2,3]. A complicating factor in the treatment of the violent patient is that many acts of aggression may be multifactorial – that is, patients may be driven to act by more than one of the three characterized forms of violence. Conventional use of psychotropic medications is often insufficient in adequately controlling violence [4], or there is hesitation on the part of treating psychiatrists to use recommended treatments such as clozapine for those that are refractory [5]. This hesitation may be due to concerns about patient compliance with blood draws, lack of familiarity in use of the medication, discomfort with managing its potential side effects, and/or fear that the medication will be discontinued if the patient is transferred back to a correctional facility. Furthermore, forensic hospital settings are limited, in some cases, in providing the appropriate environmental milieu that may serve to mitigate violent acts.

The following is a series of seven cases that illustrate the various psychopharmacological, therapeutic, and environmental interventions discussed in the California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines [6] and employed to treat each patient’s violence. All individuals were or are inpatients in smoke-free facilities with limited access to caffeinated beverages. These cases represent some of the most difficult-to-treat patients within the state hospital setting, but also provide hope for the provider in that, with aggressive and appropriate treatment, violence can be significantly reduced if not completely eliminated.

Colin A. HodgkinsonLaboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA

Brian J. HoloydaDepartment of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA

Matthew J. HoptmanSchizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, Department of Psychiatry, New York, USA, and University School of Medicine, and Department of Psychology, City University of New York, New York, USA

K. Luan PhanDepartment of Psychiatry, University of Illinois College of Medicine, Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, and Departments of Psychology, and Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois, USA

Barbara E. McDermottDepartment of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA

Jonathan M. MeyerDepartment of Psychiatry, University of California–San Diego, San Diego, California Department of State Hospitals, and Patton State Hospital, California, USA

John MonahanSchool of Law, University of Virginia, Charlottesville, Virginia, USA

Matteo PardiniDepartment of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, and Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy

Katalin A. SzaboDepartment of Psychiatry, San Mateo Health System, San Mateo, and Behavioral Health and Recovery Services, San Mateo, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

John TullyDepartment of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Stephen C. P. WongDepartment of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, School of Medicine, University of Nottingham, Nottingham, UK, and Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia